What is Prenatal Surgery? – Part 1

• The surgical treatment of the fetus before birth is called prenatal surgery or, most often, fetal surgery.
• Fetal surgery is done when the fetus is not expected to live long enough to make it through to delivery.
• This is also done when the fetus cannot live long after birth.
• Fetal surgery is done if a fetus has a severe form of congenital diaphragmatic hernia, in which the liver is located in the chest and lung development is severely restricted.
• This is to lessen the severity of the problem.
• This will permit the baby to live to birth to undergo further corrective surgery.
• Fetal surgery is a broad range of surgical techniques that are used to treat birth defects in fetuses.
• These fetuses are still in the pregnant uterus.

Types of fetal surgeries

• Open fetal surgery involves completely opening the uterus to operate on the fetus.
• Minimally invasive fetoscopic surgery (fetendo) uses small incisions and is guided by fetoscopy and sonography.
• Some fetal surgery can sometimes be done without either an incision in the uterus or an endoscopic view inside the uterus.
• This is done entirely with a real-time cross-sectional view provided by the sonogram.

Fetal surgeries in Detail

1. Fetoscopic Surgery
• Fetoscopic surgery uses a fiberoptic scope to enter the uterus through small surgical openings.
• The aim is to correct congenital malformations (birth defects) without major incisions.
• This also enables to do surgery without removing the fetus from the womb.
• This is generally less traumatic than open fetal surgery.
• It reduces the chances of preterm (premature) labor.

2. Open Fetal Surgery
• Open fetal surgery requires a hysterotomy (opening of the uterus).
• The fetus is partially removed from the uterus.
• This is done so that the area of the fetus to be operated on is exposed.
• After surgery, the fetus is returned to the uterus and the uterus is closed.
• Tocolytics are generally given to prevent labor.
• However, these should not be done if the risk is higher for the fetus inside the womb than if delivered.
• This can be like the case in intrauterine infection, unexplained vaginal bleeding and fetal distress.

3. EXIT (ex utero intrapartum treatment)
• Surgery on the fetus may be done on the fetus after a Cesarean section.
• This has to be done before the cord is cut.
• This is done so that the fetus is sustained by the mother’s placenta and does not have to breath on its own.
• This method, known as an EXIT (ex utero intrapartum treatment).
• This is employed when the fetus suffers from a congenital defect that blocks the airway.
• By the time the cord is cut and the baby has to breath, he or she has a clear airway.
• Fetal tumors can sometimes be treated before birth.
• Benign sacrococcygeal tumors can grow very large and be life-threatening
• Guided by ultrasound, radiofrequency ablation can cut off blood supply to the tumor
• This hinders the tumor’s growth so that the fetus can survive until it is delivered
• After birth the tumor can be safety removed.